Prior Authorization and Step Therapy
Prime Therapeutics, our pharmacy benefit manager, conducts all Prior Authorization (PA) and Step Therapy (ST) preauthorization requests from physicians for BCBSNM members with prescription drug coverage through Prime Therapeutics. Please continue to contact BCBSNM for all BlueSalud preauthorization requests.
Step therapy requires the use of a generic drug within the same drug class be tried and failed before a branded product may be used.
Physicians must complete and submit a preauthorization request form for all PA and ST medications. Benefits will continue to be available for medications if warranted by the patient’s medical history and current medical condition. The final decision regarding what medicines should be prescribed, regardless of benefit determination, is a decision between the patient and their doctor.
The links below will take you to the Prime Therapeutics website where you may access the PA and ST preauthorization request physician fax form. If you have questions or concerns regarding these programs, please call Prime Therapeutics at (800) 285-9426.
- Prior Authorization Fax Form List
- Step Therapy Fax Form List
- Synagis Prior Authorization Form
- PrimeMail New Prescription Fax Order Form (must be faxed from a physician's office)
Prime Therapeutics LLC is a pharmacy benefit management company. Blue Cross and Blue Shield of New Mexico (BCBSNM) contracts with Prime Therapeutics to provide pharmacy benefit management and other related services. BCBSNM, as well as several other independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics LLC.